Individual
MS. KELLY JO MEDEIROS-WHEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
21887 SW SHERWOOD BLVD STE C, SHERWOOD, OR 97140-9459
(503) 966-4154
(503) 506-0628
Mailing address
21370 SW LANGER FARMS PKWY STE 142, PMB-414, SHERWOOD, OR 97140
(503) 966-4154
(503) 506-0628
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
L4416
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500658417
—
OR
Enumeration date
11/01/2010
Last updated
03/25/2026
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